title: Recent developments in esophageal adenocarcinoma.
abstract: Answer questions and earn CME/CNE Esophageal adenocarcinoma (EAC) is characterized by 6 striking features: increasing incidence, male predominance, lack of preventive measures, opportunities for early detection, demanding surgical therapy and care, and poor prognosis. Reasons for its rapidly increasing incidence include the rising prevalence of gastroesophageal reflux and obesity, combined with the decreasing prevalence of Helicobacter pylori infection. The strong male predominance remains unexplained, but hormonal influence might play an important role. Future prevention might include the treatment of reflux or obesity or chemoprevention with nonsteroidal antiinflammatory drugs or statins, but no evidence-based preventive measures are currently available. Likely future developments include endoscopic screening of better defined high-risk groups for EAC. Individuals with Barrett esophagus might benefit from surveillance, at least those with dysplasia, but screening and surveillance strategies need careful evaluation to be feasible and cost-effective. The surgery for EAC is more extensive than virtually any other standard procedure, and postoperative survival, health-related quality of life, and nutrition need to be improved (eg, by improved treatment, better decision-making, and more individually tailored follow-up). Promising clinical developments include increased survival after preoperative chemoradiotherapy, the potentially reduced impact on health-related quality of life after minimally invasive surgery, and the new endoscopic therapies for dysplastic Barrett esophagus or early EAC. The overall survival rates are improving slightly, but poor prognosis remains a challenge.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. jesper.lagergren@ki.se
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lagergren
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001471:Barrett Esophagus / Q000473:pathology; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism; D001942:Breast Feeding; D003131:Combined Modality Therapy; D019091:Critical Pathways; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D055088:Early Detection of Cancer; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy; D018734:Genes, erbB-2; D020022:Genetic Predisposition to Disease; D012739:Gonadal Steroid Hormones / Q000378:metabolism; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D009765:Obesity / Q000150:complications / Q000628:therapy; D010166:Palliative Care; D011184:Postoperative Period; D011300:Preoperative Care; D011322:Primary Prevention; D011379:Prognosis; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D011788:Quality of Life; D012307:Risk Factors; D017678:Sex Distribution; D015607:Stents; D015431:Weight Loss
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D014408:Biomarkers, Tumor; D012739:Gonadal Steroid Hormones; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D054328:Proton Pump Inhibitors
keywords: Barrett esophagus; esophagus; health-related quality of life; incidence; neoplasm; patterns; prognosis; therapy